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PLUMBING FIXTURES BEING INSTALLED � <br /> FIXTliRE BSM"I' I�� 2ND OTI If:R I'IXTURF. [3SM'I' 1'� 2"D O"fl II?R <br /> TYPE I�L FI, 'I'YPE FL I�I. <br /> Water Closet � �loor Drains � <br /> Lavatory � Sewer Ejector <br /> --- ______ <br /> [3athroom � Laundry"1'ray � <br /> — —�--_ ...--- _---- _ -—_ -- -- <br /> Shower � W asher � <br /> Kitchen Sink � Water Heater � � <br /> .:is���a{ Watc:r Soitener �� � <br /> Uishwasher � Wet Bar <br /> Sillcocks Miscellaneous <br /> -- --- ��•�5�� — ----- ---- - —_ _ __ I <br /> PERMIT FEE CALCULATION(S) � <br /> BASED OFF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replaccment of a Residential fixture or appliance that meets all thrcc of the following rcquircments: <br /> I. Does not require modification to electrical or gas service. <br /> 2. lias a total cost of$500.00 or less;excludin�the cost of the fixture or appliance: ��nd <br /> 3. Is improved, installed or replaced by the homeowner or liccnsed conU-actor. <br /> Skip next section, if this applies; Cost of Permit $ I 5.00 <br /> State Surcharge $ .50 <br /> Mail-[n F�ee(lf�pplicablc) $ 1.50 <br /> "I�otal Pcr�nit Fcc $ <br /> (Permit Fees Continued On Next Page) <br /> 2 <br />